Video 4.12: Deep SMAS Suture – Increasing Tip Support and Rotation in Closed Rhinoplasty

What this video shows

Video 4.12 presents the surgical technique of the deep SMAS suture, published by the author in Plastic and Reconstructive Surgery as 'A New Way for Supporting Tip Projection in Closed Rhinoplasty: Using the Medial Deep SMAS Layer'. During a closed operation, the hemitransfixion incision exposes the area where the deep SMAS adheres to the anterior septal angle; this attachment is held with a loop suture and transposed higher.

The book explains the logic: separation of this adhesion point causes tip dropping, vertical plication gives supratip definition and horizontal plication causes supratip bulging, whereas transposing the point higher increases tip support and rotation while shortening the nose. Indications and contraindications are summarised in Table 4.6.

Key points

• Deep SMAS attachment at the anterior septal angle is captured with a loop suture.

• Transposing it higher increases tip support and rotation and shortens the nose.

• Performed entirely through the closed approach.

In the book: Chapter 4 – Nasal Tip Surgery, section 4.3.9 Deep SMAS Suture – 4.3.9.1 Surgical Technique, pp. 98–100 of Rhinoplasty in Practice: An Algorithmic Approach to Modern Surgical Techniques (CRC Press, 2021). About the book and all companion videos.

Related publication record: A New Way for Supporting Tip Projection in Closed Rhinoplasty: Using the Medial Deep SMAS Layer.

Surgeon: Prof. Dr. Suleyman Tas, plastic, reconstructive and aesthetic surgeon, Istanbul. This video is part of the surgeon-training material of the book; patients considering rhinoplasty in Istanbul can use it to understand the techniques used at Prof. Dr. Suleyman Tas Clinic.